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Biomedical subjects

E A Reece

Publications and source records attributed to E A Reece.

At least 163 records · Page 9Linked to original sources
PubMed1986

A randomized clinical trial of the insulin pump vs intensive conventional therapy in diabetic pregnancies.

Improved perinatal outcome is associated with the prevention of hyperglycemia during pregnancy in diabetic women. To determine whether the method of insulin administration influences the degree of diabetic control obtained, we randomized 22 pregnant diabetic women to intensive conventional insulin therapy (N = 11) and insulin pump therapy (N = 11). Frequent outpatient visits; home glucose monitoring, at least six times daily; and frequent telephone contact were offered to all subjects. Patients were hospitalized in the inpatient clinical research center each trimester for a 24-hour metabolic profile. There were no differences between the two treatment groups with respect to outpatient mean glucose levels, symptomatic hypoglycemia, or glycosylated hemoglobin levels, or with respect to inpatient mean glucose level, glycemic excursions, chemical hypoglycemia, or hyperglycemia. Excellent metabolic control was achieved with both treatment methods.

Adult↗
PubMed1986

Yolk sac failure in embryopathy due to hyperglycemia: ultrastructural analysis of yolk sac differentiation associated with embryopathy in rat conceptuses under hyperglycemic conditions.

Diabetes mellitus in pregnancy is associated with an increased incidence of various congenital anomalies that occur during organogenesis. Because a well functioning yolk sac is crucial to embryonic growth and development during this period, we performed an ultrastructural study of the effects of excess glucose (total glucose 750 mg/dl, osmolality 305 mOsm/kg) on pregnancy day 10 (Witschi stage 13) rat conceptuses cultured for 48 hr in heat-inactivated male rat serum with and without added d- or l-glucose. Embryos exposed to excess d-glucose demonstrated decreased conceptus size (P less than 0.001), and gross malformations in a dose-related fashion. The visceral yolk sac capillaries and vitelline vessels of conceptuses in excess d-glucose were sparse, patchy, and nonuniformly located. Ultrastructurally, the visceral yolk sac endodermal cells had reduced numbers of rough endoplasmic reticulum, ribosomes, and mitochondria. These obvious defects in yolk sac structure suggest that hyperglycemia during organogenesis has a primary deleterious effect on yolk sac function with resultant embryopathy.

Animals↗
PubMed1986

Prenatal diagnosis of craniofacial malformations with ultrasonography.

Although the utility of ultrasound in the prenatal diagnosis of many congenital anomalies is well established, its accuracy in detecting craniofacial malformations has not been examined in a large series. Sonographic examinations of 223 patients at risk for fetuses with craniofacial malformations were performed between 18 and 40 weeks. The risk factors included a familial history of craniofacial malformations, extrafacial anomalies diagnosed on ultrasound, fetal chromosomal aberrations, and maternal drug intake. Sonographic diagnosis was possible in 151 (67.7%) patients on the first scan and in 47 (21.1%) patients on the second scan and was not possible in 25 patients (11.2%). Of the 198 cases diagnosed antenatally, craniofacial malformation was detected in 14 and confirmed postnatally. No false positive diagnoses were made. A negative diagnosis of craniofacial malformation was made in 184 cases with two false negative results (1.0%). Anomalies diagnosed sonographically included anophthalmia, anterior cleft lip and/or palate, hypotelorism, hypertelorism, and micrognathia. The results of this study demonstrate that ultrasound is an accurate and reliable tool for the prenatal diagnosis of craniofacial malformations.

Face↗
PubMed1986

Coronary artery disease in diabetic pregnancies.

Severe vascular complications of diabetes mellitus include myocardial infarction and when this occurs during pregnancy it is associated with a high risk of maternal mortality. In the absence of myocardial infarction, information is unavailable on pregnancy outcome in diabetic patients with severe coronary artery disease or with prior coronary artery bypass graft. Such a case is presented together with a review of the literature.

Adult↗
PubMed1986

The prenatal diagnosis of Robin anomalad.

The Robin anomalad was diagnosed by the sonographic detection of polyhydramnios and fetal micrognathia in a patient at risk because of a previously affected child. Ultrasound in the second trimester failed to demonstrate any facial anomaly, but mandibular hypoplasia was clearly documented in the third trimester. The antenatal diagnosis allowed immediate neonatal assistance to prevent glossoptosis-induced respiratory failure.

Adult↗
PubMed1986

Arachidonic acid prevents hyperglycemia-associated yolk sac damage and embryopathy.

Light microscopic, electron microscopic, and morphometric studies were performed on rat conceptuses cultured between day 10 and day 12 in normal, hyperglycemic, arachidonic acid-supplemented normal, and arachidonic acid-supplemented hyperglycemic rat serum. The results were compared with those of 12-day-old conceptuses grown in utero. No major differences were observed between in vivo and in vitro control conceptuses. Arachidonic acid supplementation of control culture medium resulted in an improvement of conceptus development. Addition of 20 micrograms/ml of arachidonic acid to an otherwise teratogenic hyperglycemic serum medium (950 mg/dl of D-glucose) prevented the malformations induced by hyperglycemic conditions: open neural tube, advanced neuropil formation in the neuroepithelium, significant reduction of rough endoplasmic reticulum, decreased size and number of lipid droplets, and increased number of lysosome-like structures in the visceral endodermal yolk sac cells.

Animals↗
PubMed1986

Percutaneous umbilical blood sampling in the management of Kell isoimmunization.

As the use of Rhesus immune globulin has decreased the incidence of Rh sensitization, other red blood cell antigen systems have become relatively more common. The most common of these is the Kell antigen, which often produces unexpectedly severe fetal disease. High-resolution ultrasound was used to guide in the sampling of fetal blood directly from the umbilical cord as an aid in the management of these patients.

Adult↗
PubMed1986

Intrapartum fetal weight estimation: a comparison of three formulae.

To determine the relative accuracy of fetal weight estimation using the biparietal diameter (BPD), the abdominal circumference (AC), and the femur length (FL) in three formulae (BPD/AC, FL/AC, and BPD/AC/FL), 63 patients in labor were examined. All patients delivered within 24 hours of ultrasound examination. A good correlation was found between the estimated fetal weight and the actual birth weight, using the three formulae: BPD/AC (r = 0.96); FL/AC (r = 0.95); and BPD/AC/FL (r = 0.96). The FL/AC formula overestimated fetal weight (P less than 0.01), however, particularly in fetuses weighing more than 2000 g. The mean percentage error with the BPD/AC formula was 0.99 per cent, 3.82 per cent with the FL/AC, and 2.43 per cent with the BPD/AC/FL formula. This study showed that although all three formulae were comparable, the best estimation of the birth weight was obtained when either the BPD/AC or the BPD/AC/FL formulae were used. Additionally, the results demonstrate that reliable estimates of fetal weight can be made even at term or in laboring patients.

Birth Weight↗
PubMed1986

Diabetic embryopathy: pathogenesis, prenatal diagnosis and prevention.

In spite of the overall improvement in the management of diabetic pregnancies, congenital anomalies among infants of diabetic mothers still remain two to three times higher than in the nondiabetic population. Approximately 40 per cent of all perinatal deaths among diabetic offspring are due to congenital malformations. This article reviews the subject and discusses current views on pathogenesis, based on human and experimental work, describes methods available for prenatal diagnosis, and suggests an approach to the possible prevention of these malformations.

Congenital Abnormalities↗
PubMed1985

Percutaneous umbilical blood sampling.

This report describes a technique for the performance of a sonographically guided percutaneous umbilical blood sampling and its potential uses in the management of diagnostic problems in the second and third trimester of pregnancy. The method has been employed in the prenatal assessment of 13 fetuses at risk for hemostatic failure (hemophilia and idiopathic thrombocytopenic purpura), chromosomal disorders, isoimmunization, and fetal hypoxia. This simple and rapid procedure offers access to the fetal circulation for diagnostic and therapeutic purposes.

Adult↗
PubMed1985

Antenatal diagnosis of renal anomalies with ultrasound. III. Bilateral renal agenesis.

Bilateral renal agenesis is a lethal congenital anomaly. A reliable prenatal diagnosis is extremely important, since it may offer options for pregnancy termination or may change obstetric management in the third trimester. This study examined the accuracy of ultrasound in making an antenatal diagnosis of bilateral renal agenesis in three different populations: (1) patients with a family history of bilateral renal agenesis, (2) patients diagnosed during the course of a routine scan, and (3) patients referred because of a previous suspicious ultrasound examination in a level I ultrasound facility. In group A there were three true positive, 13 true negative, no false negative, and no false positive diagnoses. In group B there were three true positive and no false positive diagnoses. In group C there were 12 true positive, 17 true negative, one false negative, and no false positive diagnoses. The value and potential pitfall of the different diagnostic criteria are discussed. We conclude that ultrasound is a valuable tool in the detection of intrauterine renal failure, although there are limitations to a specific diagnosis of bilateral renal agenesis.

Evaluation Studies as Topic↗
PubMed1985

Sonographic monitoring to guide the performance of postabortal uterine curettage.

This communication describes a technique of sonographically monitored uterine curettage. This method is of particular value in the management of postabortal endomyometritis associated with retained products of conception or in any situation in which anatomic variation (for instance, retroversion) makes curette insertion difficult.

Dilatation and Curettage↗
PubMed1985

Ultrastructural analysis of malformations of the embryonic neural axis induced by in vitro hyperglycemic conditions.

Neural tube defects are the most common malformations associated with diabetic pregnancies. Although the teratogenic effects of excess glucose have been investigated in in vivo and in vivo studies, a cellular basis for neural tube defects has not been elucidated. We used rat embryo culture to study the organogenesis period of development, with excess d-glucose added to the serum medium to induce neural tube anomalies. Light and electron microscopic examination of control 12-day-old embryos grown 48 hours in culture revealed blastlike cells with few organelles or cellular processes. Twelve-day-old embryos cultured in excess d-glucose had advanced cellular maturation with differentiation, including the presence of free polysomes and copious cell processes, regardless of whether they had an open neural tube. Cytoarchitectural changes such as decreased numbers of mitotic figures with mitotic cells in the mantle layer were focally distributed throughout the neural epithelium but with predominance at the site of failed closure. In vivo studies failed to demonstrate neural processes in day 12 normal embryos. Fourteen-day-old embryos grown in utero also had foci of cell processes in the neural tube but to a much lesser degree than that observed in the in vitro day 12 glucose-exposed embryos. The cellular aberrations in the excess d-glucose-treated embryos are characteristic of a premature maturational change. Since they are present in excess d-glucose-exposed embryos with or without failure of neural tube closure, these maturational and cytoarchitectural changes may contribute to the cellular basis for neural tube defects.

Animals↗
PubMed1985

Prenatal diagnosis of Candida albicans chorioamnionitis.

The use of diagnostic amniocentesis has been proposed for the evaluation of patients with clinical suspicion of chorioamnionitis, such as those with premature rupture of membranes and premature labor. We describe a patient in whom the diagnosis of Candida chorioamnionitis was made after diagnostic amniocentesis with the assistance of a simple and rapidly performed potassium hydroxide smear.

Adult↗
PubMed1985

Clavicular measurement: a new biometric parameter for fetal evaluation.

Fetal clavicular length was measured sonographically in 85 fetuses with gestational ages ranging from 15 to 40 weeks. Biparietal diameter (BPD) and femur length (FL) were also measured. A linear correlation was found between clavicular length and gestational age (coefficient of correlation = 0.81). A simple relation was found: The gestational age in weeks is approximately equal to the length of the clavicle as expressed in millimeters. The measurement of clavicular length can be a useful parameter for the estimation of gestational age and in the detection of congenital anomalies that affect the clavicles. Clavicular measurements may also prove useful in the detection of macrosomic fetuses at high risk for obstructed labor or shoulder dystocia.

Anthropometry↗
PubMed1985

Sonographically monitored amniocentesis to decrease intraoperative complications.

The rates of intraoperative complications (dry and bloody taps) of two amniocentesis techniques were compared in 1300 patients undergoing second trimester procedures for genetic indications. The sonographically guided technique consisted of the selection of a site for needle insertion with ultrasound, removal of the transducer, and immediate amniocentesis. The sonographically monitored technique consisted of the continuous visualization of the needle during the entire procedure. Six hundred twelve amniocenteses were performed with the sonographically guided technique and 688 with the sonographically monitored technique. There was a statistically significant decrease in the incidence of bloody and dry taps of the first needle insertion (relative risk = 38%, P less than .0001) and also in the number of patients that required multiple needle insertions (relative risk = 42%, P less than .0001) with the sonographically monitored technique.

Amniocentesis↗
PubMed1985

Systemic lupus erythematosus in pregnancy.

Women with SLE are at risk for developing a greater number of complications during pregnancy and have a lesser chance for a successful outcome for the conceptus than do normal healthy gravidas. These complications probably result, at least in part, from the action of estrogens to stimulate the underlying immunologic disorder of SLE. In addition, women with hypertension, renal functional abnormalities, or other complications resulting from SLE are likely to share the same risk factors as women with these afflictions due to non-SLE disorders. Recent studies, however, show that the incidence of clinical flares during pregnancy and diminished fetal survival are not as exaggerated as were described in earlier reports and small case series, probably owing to more adequate suppression of SLE activity with glucocorticoids and immunosuppressive drugs, and to improvements in fetal monitoring and maternal care. Women in complete clinical remission, regardless of previous manifestations of SLE, appeared to have the best outlook for uncomplicated pregnancies and the highest incidence of fetal survival. In our judgment, gravidas with established SLE should be managed in a perinatal program with an expertise available for careful systematic fetal monitoring; ready access to consultants in nephrology, rheumatology, and other relevant disciplines; and inpatient facilities for complicated gestations. In addition, all women with SLE should be screened for anti-Ro (SS-A) antibodies in order to identify fetuses at risk for cardiac conduction defects. Women with a history of recurrent in utero fetal deaths or spontaneous abortions should be screened for LE-anticoagulant, even in the absence of clinical signs of SLE.

Estrogens↗